Department of General Practice and Primary Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Primary Medical Care, University of Luebeck, Luebeck, Germany.
Fam Pract. 2022 May 28;39(3):346-353. doi: 10.1093/fampra/cmab138.
Depression and anxiety are more prevalent in patients with heart failure (HF) than in the general population and reduce quality of life (QoL); therefore, clinical guidelines recommend screening HF patients for depression/anxiety.
We investigated, whether the general practitioners' (GPs) awareness of patients' symptoms of depression and/or anxiety (psychosocial distress) was associated with a change in QoL.
In this prospective observational study, we recruited 3,129 primary care HF patients in Germany. Patients completed baseline and 12-month follow-up questionnaires. Their GPs were interviewed. We identified 666 patients with psychosocial distress and compared 2 groups by analysis of covariance: 235 patients with psychosocial distress whose GP was aware of the psychosocial distress and 431 patients with psychosocial distress whose GP was unaware of such distress. Primary outcome was the change in QoL, assessed by the EQ-5D visual analogue scale.
Patients with psychosocial distress showed lower baseline QoL than those without (45.9 vs 64.1; P < 0.001). Within the patients with psychosocial distress, the GPs' awareness of psychosocial distress was not associated with improvement of QoL (F = 1.285; P = 0.258) or remission of psychosocial distress (odds ratio = 0.887; P = 0.608).
We found no association between the GPs' awareness of psychosocial distress and change in QoL. Although data for effective treatments of depression in HF are currently insufficient, psychosocial distress strongly impairs the QoL in HF patients. These findings might influence the development of clinical practice guidelines in HF.
与一般人群相比，心力衰竭（HF）患者中更常见抑郁和焦虑，且降低生活质量（QoL）；因此，临床指南建议对 HF 患者进行抑郁/焦虑筛查。
我们研究了全科医生（GPs）对患者抑郁和/或焦虑症状（心理社会困扰）的认识是否与 QoL 的变化相关。
在这项前瞻性观察性研究中，我们在德国招募了 3129 名初级保健 HF 患者。患者完成基线和 12 个月随访问卷。对他们的 GPs 进行访谈。我们确定了 666 名有心理社会困扰的患者，并通过协方差分析比较了 2 组：235 名有心理社会困扰且其 GP 知晓心理社会困扰的患者和 431 名有心理社会困扰但 GP 不知晓的患者。主要结局是通过 EQ-5D 视觉模拟量表评估的 QoL 变化。
有心理社会困扰的患者的基线 QoL 低于无心理社会困扰的患者（45.9 比 64.1；P<0.001）。在有心理社会困扰的患者中，GPs 对心理社会困扰的认识与 QoL 的改善无关（F=1.285；P=0.258）或心理社会困扰的缓解无关（比值比=0.887；P=0.608）。
我们没有发现 GPs 对心理社会困扰的认识与 QoL 的变化之间存在关联。尽管目前 HF 中治疗抑郁的有效数据不足，但心理社会困扰严重损害 HF 患者的 QoL。这些发现可能会影响 HF 临床实践指南的制定。
